Keloid is NOT a condition that can be treated with surgery. Indeed, many patients experience worsening of their keloids after surgery. This is simply because keloid is a genetic disorder of the wound healing mechanism of the skin. As the skin heals after an injury, for example after ear piercing, or after a cut, the wound healing response heals the wound. In patients with keloid disorder, the wound healing mechanism heals the wound, but does not stop after enough healing has taken place. It is the abnormal continuation of the wound healing response that leads to formation of keloids.
Many people pierce their ears, but only few develop ear keloids. That is because the few have the genetic abnormality. In removing an ear keloid, surgeon’s scalpel causes a much larger injury that the piercing itself. The larger the size of injury is, the larger the subsequent keloid will be. Although surgery can help some keloid patients, unfortunately, there are way too many whose keloids have significantly worsened after surgery. Although reported in individuals from almost all ethnic backgrounds, the disorder is more common among Africans / African Americans and Asians.
Keloid Disorder has a very diverse appearance and can present itself either as a single small spot on the skin, or as numerous large keloids in different places. In some patients, keloid lesions can grow and form a large size skin tumor. From the onset of development, keloids follow variable paths. Some patients develop only one keloid and that keloid reaches a particular size and thereafter, it stops growing. There are also patients who start with one keloid and soon they develop their second, third, fourth and before they know, they have far too many keloids to count.
Although keloid disorder has been known for centuries, it is one the most under-researched and poorly understood human medical conditions. There are many aspects of this disorder such as its genetics, epidemiology, pathophysiology that are not well researched. Even proper terminology and nomenclature for the disorder is lacking. Many by mistake call it a scar, or refer to it as keloid scar and this wrong naming method has prompted insurance companies not pay for the cost of medical care, as they don’t pay for treatment of scars, as they consider scar improvement as a cosmetic procedure.
Calling it scar erroneously implies to a lesser importance to this genetic skin disorder. A genetic condition that results in formation of large skin tumors, or itching, pain and burning sensation, a condition that interfered with your daily life, a condition that some treat it with radiation therapy, is not a “scarring”.
CLASSIFICATION OF KELOIDS
Keloid lesions take on a variety of shapes and forms and appear in any part of the skin. The lesions can be classified according to their appearance. These are all discussed under the heading of Keloid Types in this website. Keloid lesions can develop in unique and well-defined parts of the skin as you can see in the navigation bar of this website.
Like all other aspects of Keloid Disorder, epidemiology of this disorder, its true incidence and prevalence has never been properly studied. True incidence and prevalence of keloid in Unites States is not known. Unfortunately, Center for Disease Control (CDC) does not follow this disorder, therefore we have no reliable indication as to its incidence or prevalence in United States. World Health Organization (WHO) does not follow this disorder either. Keloid Disorder is quite common in sub-Saharan Africa and Asia.
Most keloid patients have a positive family history of keloid disorder. Development of keloids among twins also lends credibility to existence of a genetic susceptibility to develop keloids. Genetic basis of keloid disorder is poorly understood and is an area that has not been properly researched.
The pathogenesis of keloid disorder is for most part unknown and poorly understood. Culprit in formation of keloid lesion is the wounding of the skin in a genetically prone individual. Disruption in the normal anatomy of the skin and subsequent genetically driven dysregulated wound healing, leads to formation of keloid lesions. Worsening of the keloids after surgical excision is most probably due to triggering of the same dysregulated wound healing mechanisms, yet to a new dermal injury that is more extensive in nature, than the original triggering injury, for instance from the ear piercing.
Another important factor in pathogenesis of keloid is age of onset of keloid, which peaks at puberty and early teens. The section is separately discussed in this website.
We hope that this brief overview has provides you with some basic understanding of keloid disorder. Please explore this website, as it contains plenty of useful information and links to reputable resources.
The video below is a summary of the keloid disorder that was presented by Dr. Tirgan at a medical meeting.
Michael H. Tirgan, MD